The present invention relates generally to an approach for improved analysis of complex billing processes. For example, the billing and reimbursement process associated with the Medicare or other large government programs is very complex in which a number of parties interact in the entire process of generating the billing information and receiving and tracking the payment corresponding to the billing information. Furthermore, it is also very difficult to audit and track the billing information and the payment received to the underlying services for which the billing and payment is performed. For example, in the context of Medicare, this process involves the provision of medical and laboratory test services to a patient and the reimbursement of the costs thereof from a paying party, such as the authorities that manage the Medicare program.
In this complex process, any errors in the billing process (by a provider of services) may result in the denial of payment by the paying authority. Furthermore, other errors in the billing process by the provider of services may result in an audit by an audit entity or result in fines to the provider simply because the billing process was not managed correctly. Therefore, there is a need for a more efficient process for managing and analyzing the billing process in a complex billing and payment process such as that used in the Medicare billing and payment process.
Furthermore, the provider laboratories are not only responsible for controlling how the services are billed but they are often also responsible for keeping documentation about their compliance with applicable government and other regulations. For example, for Medicare billing and payment, the Office of the Inspector General (OIG) has compliance guidelines which provider laboratories are expected to adhere to.